Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2020

23.05.2019 | KNEE

Medial collateral ligament (MCL) reconstruction results in improved medial stability: results from the Danish knee ligament reconstruction registry (DKRR)

verfasst von: Martin Lind, Kevin Jacobsen, Torsten Nielsen

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 3/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The aim of this study was to compare outcome data after isolated and combined (MCL) plus anterior cruciate ligament (ACL) reconstruction based on objective and subjective measures using data from the (DKRR). There are only a few small-sized case studies on outcomes after MCL reconstruction. MCL reconstruction was hypothesised to improve both objective and subjective outcomes.

Methods

All patients who were registered in the DKRR between 2005 and 2016 (N = 25,281) and who underwent isolated ACL (n = 24,683), isolated MCL (n = 103) or combined MCL plus ACL (n = 495) reconstructions were retrospectively identified. Objective (valgus knee stability and sagittal knee laxity) and subjective (Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity scale score) outcomes in these three cohorts were evaluated at the 1-year follow-up by comparing pre- and post-operative values.

Results

Medial stability improved significantly pre- to post-operatively after both isolated MCL and combined MCL plus ACL reconstruction, with 26 (53%) and 195 (69%) of the patients, respectively, having normal valgus stability (0–2 mm laxity). Sagittal stability was similar after MCL plus ACL reconstruction and isolated ACL reconstruction (1.7 and 1.5 mm, respectively). At the 1-year follow-up, although the KOOS of the patients in the isolated MCL and combined MCL plus ACL reconstruction cohorts improved significantly, they were lower than those of the patients in the isolated ACL reconstruction cohort.

Conclusion

Both isolated MCL reconstruction and combined MCL plus ACL reconstruction resulted in significant and clinically relevant improvements in the subjective outcomes from pre-operative conditions to the 1-year follow-up. Valgus stability also improved significantly, with two-thirds of patients obtaining normal valgus stability after MCL reconstruction. Subjective outcomes were similar between isolated MCL reconstruction and combined MCL plus ACL reconstructions, but were poorer than isolated ACL reconstructions.

Level of evidence

Level III.
Literatur
1.
Zurück zum Zitat Al-Hourani K, Jefferies J, Will E, Keating JF (2015) Recovery of knee function in the isolated MCL and combined ACL-MCL deficient knee. J Clin Orthop Trauma 6(2):89–93CrossRef Al-Hourani K, Jefferies J, Will E, Keating JF (2015) Recovery of knee function in the isolated MCL and combined ACL-MCL deficient knee. J Clin Orthop Trauma 6(2):89–93CrossRef
2.
Zurück zum Zitat Council on Scientific Affairs (American Medical Association) Advisory Panel on Standard Nomenclature of Athletic Injuries, American Medical Association (1976) Standard nomenclature of athletic injuries. American Medical Association, Monroe, WI Council on Scientific Affairs (American Medical Association) Advisory Panel on Standard Nomenclature of Athletic Injuries, American Medical Association (1976) Standard nomenclature of athletic injuries. American Medical Association, Monroe, WI
3.
Zurück zum Zitat Azar FM (2006) Evaluation and treatment of chronic medial collateral ligament injuries of the knee. Sports Med Arthrosc Rev 14(2):84–90CrossRef Azar FM (2006) Evaluation and treatment of chronic medial collateral ligament injuries of the knee. Sports Med Arthrosc Rev 14(2):84–90CrossRef
4.
Zurück zum Zitat Bosworth DM (1952) Transplantation of the semitendinosus for repair of laceration of medial collateral ligament of the knee. J Bone Jt Surg Am 34-A(1):196–202CrossRef Bosworth DM (1952) Transplantation of the semitendinosus for repair of laceration of medial collateral ligament of the knee. J Bone Jt Surg Am 34-A(1):196–202CrossRef
5.
Zurück zum Zitat Chen LC, Cooley VJ, Rosenberg TD (2002) Medial collateral ligament healing response technique: microperforation. Tech Knee Surg 1(1):36–42CrossRef Chen LC, Cooley VJ, Rosenberg TD (2002) Medial collateral ligament healing response technique: microperforation. Tech Knee Surg 1(1):36–42CrossRef
6.
Zurück zum Zitat DeLong JM, Waterman BR (2015) Surgical Techniques for the reconstruction of medial collateral ligament and posteromedial corner injuries of the knee: a systematic review. Arthroscopy 31(11):2258–2272 (e2251) CrossRef DeLong JM, Waterman BR (2015) Surgical Techniques for the reconstruction of medial collateral ligament and posteromedial corner injuries of the knee: a systematic review. Arthroscopy 31(11):2258–2272 (e2251) CrossRef
7.
Zurück zum Zitat Domnick C, Garcia P, Raschke MJ, Glasbrenner J, Lodde G, Fink C, Herbort M (2017) Trends and incidences of ligament-surgeries and osteotomies of the knee: an analysis of German inpatient records 2005–2013. Arch Orthop Traum Surg 137(7):989–995CrossRef Domnick C, Garcia P, Raschke MJ, Glasbrenner J, Lodde G, Fink C, Herbort M (2017) Trends and incidences of ligament-surgeries and osteotomies of the knee: an analysis of German inpatient records 2005–2013. Arch Orthop Traum Surg 137(7):989–995CrossRef
8.
Zurück zum Zitat Edson CJ (2006) Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc Rev 14(2):105–110CrossRef Edson CJ (2006) Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc Rev 14(2):105–110CrossRef
9.
Zurück zum Zitat Ellsasser JC, Reynolds FC, Omohundro JR (1974) The non-operative treatment of collateral ligament injuries of the knee in professional football players. An analysis of seventy-four injuries treated non-operatively and twenty-four injuries treated surgically. J Bone Jt Surg Am 56(6):1185–1190CrossRef Ellsasser JC, Reynolds FC, Omohundro JR (1974) The non-operative treatment of collateral ligament injuries of the knee in professional football players. An analysis of seventy-four injuries treated non-operatively and twenty-four injuries treated surgically. J Bone Jt Surg Am 56(6):1185–1190CrossRef
10.
Zurück zum Zitat Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS (2010) A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med 363(4):331–342CrossRef Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS (2010) A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med 363(4):331–342CrossRef
11.
Zurück zum Zitat Granan LP, Bahr R, Steindal K, Furnes O, Engebretsen L (2008) Development of a national cruciate ligament surgery registry: The Norwegian National Knee Ligament Registry. Am J Sports Med 36(2):308–315CrossRef Granan LP, Bahr R, Steindal K, Furnes O, Engebretsen L (2008) Development of a national cruciate ligament surgery registry: The Norwegian National Knee Ligament Registry. Am J Sports Med 36(2):308–315CrossRef
12.
Zurück zum Zitat Grant JA, Tannenbaum E, Miller BS, Bedi A (2012) Treatment of combined complete tears of the anterior cruciate and medial collateral ligaments. Arthroscopy 28(1):110–122CrossRef Grant JA, Tannenbaum E, Miller BS, Bedi A (2012) Treatment of combined complete tears of the anterior cruciate and medial collateral ligaments. Arthroscopy 28(1):110–122CrossRef
13.
Zurück zum Zitat Jones L, Bismil Q, Alyas F, Connell D, Bell J (2009) Persistent symptoms following non operative management in low grade MCL injury of the knee—the role of the deep MCL. Knee 16(1):64–68CrossRef Jones L, Bismil Q, Alyas F, Connell D, Bell J (2009) Persistent symptoms following non operative management in low grade MCL injury of the knee—the role of the deep MCL. Knee 16(1):64–68CrossRef
14.
Zurück zum Zitat Kannus P (1988) Long-term results of conservatively treated medial collateral ligament injuries of the knee joint. Clin Orthop Relat Res 226:103–112 Kannus P (1988) Long-term results of conservatively treated medial collateral ligament injuries of the knee joint. Clin Orthop Relat Res 226:103–112
15.
Zurück zum Zitat Kim C, Chasse PM, Taylor DC (2016) Return to play after medial collateral ligament injury. Clin Sports Med 35(4):679–696CrossRef Kim C, Chasse PM, Taylor DC (2016) Return to play after medial collateral ligament injury. Clin Sports Med 35(4):679–696CrossRef
16.
Zurück zum Zitat Konstantinos M, Georgios K, Konstantinos S, Georgios T (2016) The evolution of the surgical treatment of sports injuries in the 20th century: a historical perspective. Surg Innov 23(5):538–542CrossRef Konstantinos M, Georgios K, Konstantinos S, Georgios T (2016) The evolution of the surgical treatment of sports injuries in the 20th century: a historical perspective. Surg Innov 23(5):538–542CrossRef
17.
Zurück zum Zitat LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Jt Surg Am 89(9):2000–2010CrossRef LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Jt Surg Am 89(9):2000–2010CrossRef
18.
Zurück zum Zitat Laprade RF, Wijdicks CA (2012) The management of injuries to the medial side of the knee. J Orthop Sports Phys Ther 42(3):221–233CrossRef Laprade RF, Wijdicks CA (2012) The management of injuries to the medial side of the knee. J Orthop Sports Phys Ther 42(3):221–233CrossRef
19.
Zurück zum Zitat Laprade RF, Wijdicks CA (2012) Surgical technique: development of an anatomic medial knee reconstruction. Clin Orthop Relat Res 470(3):806–814CrossRef Laprade RF, Wijdicks CA (2012) Surgical technique: development of an anatomic medial knee reconstruction. Clin Orthop Relat Res 470(3):806–814CrossRef
20.
Zurück zum Zitat Lind M, Jakobsen BW, Lund B, Hansen MS, Abdallah O, Christiansen SE (2009) Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability. Am J Sports Med 37(6):1116–1122CrossRef Lind M, Jakobsen BW, Lund B, Hansen MS, Abdallah O, Christiansen SE (2009) Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability. Am J Sports Med 37(6):1116–1122CrossRef
21.
Zurück zum Zitat Lind M, Menhert F, Pedersen AB (2009) The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 17(2):117–124CrossRef Lind M, Menhert F, Pedersen AB (2009) The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 17(2):117–124CrossRef
22.
Zurück zum Zitat Lundblad M, Waldén M, Magnusson H, Karlsson J, Ekstrand J (2013) The UEFA injury study: 11-year data concerning 346 MCL injuries and time to return to play. Br J Sports Med 47(12):759–762CrossRef Lundblad M, Waldén M, Magnusson H, Karlsson J, Ekstrand J (2013) The UEFA injury study: 11-year data concerning 346 MCL injuries and time to return to play. Br J Sports Med 47(12):759–762CrossRef
23.
Zurück zum Zitat Majewski M, Susanne H, Klaus S (2006) Epidemiology of athletic knee injuries: a 10-year study. Knee 13(3):184–188CrossRef Majewski M, Susanne H, Klaus S (2006) Epidemiology of athletic knee injuries: a 10-year study. Knee 13(3):184–188CrossRef
24.
Zurück zum Zitat Maletis GB, Inacio MC, Funahashi TT (2013) Analysis of 16,192 anterior cruciate ligament reconstructions from a community-based registry. Am J Sports Med 41(9):2090–2098CrossRef Maletis GB, Inacio MC, Funahashi TT (2013) Analysis of 16,192 anterior cruciate ligament reconstructions from a community-based registry. Am J Sports Med 41(9):2090–2098CrossRef
25.
Zurück zum Zitat Mall NA, Chalmers PN, Moric M, Tanaka MJ, Cole BJ, Bach BR Jr, Paletta GA Jr (2014) Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 42(10):2363–2370CrossRef Mall NA, Chalmers PN, Moric M, Tanaka MJ, Cole BJ, Bach BR Jr, Paletta GA Jr (2014) Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 42(10):2363–2370CrossRef
26.
Zurück zum Zitat Millett PJ, Pennock AT, Sterett WI, Steadman JR (2004) Early ACL reconstruction in combined ACL-MCL injuries. J Knee Surg 17(2):94–98CrossRef Millett PJ, Pennock AT, Sterett WI, Steadman JR (2004) Early ACL reconstruction in combined ACL-MCL injuries. J Knee Surg 17(2):94–98CrossRef
27.
Zurück zum Zitat Nordenvall R, Bahmanyar S, Adami J, Mattila VM, Fellander-Tsai L (2014) Cruciate ligament reconstruction and risk of knee osteoarthritis: the association between cruciate ligament injury and post-traumatic osteoarthritis. a population based nationwide study in Sweden, 1987–2009. PLoS ONE 9(8):e104681CrossRef Nordenvall R, Bahmanyar S, Adami J, Mattila VM, Fellander-Tsai L (2014) Cruciate ligament reconstruction and risk of knee osteoarthritis: the association between cruciate ligament injury and post-traumatic osteoarthritis. a population based nationwide study in Sweden, 1987–2009. PLoS ONE 9(8):e104681CrossRef
28.
Zurück zum Zitat O’Donoghue DH (1973) Reconstruction for medial instability of the knee. J Bone Jt Surg Am 55(5):941–954CrossRef O’Donoghue DH (1973) Reconstruction for medial instability of the knee. J Bone Jt Surg Am 55(5):941–954CrossRef
29.
Zurück zum Zitat Papalia R, Osti L, Del Buono A, Denaro V, Maffulli N (2010) Management of combined ACL-MCL tears: a systematic review. Br Med Bull 93(1):201–215CrossRef Papalia R, Osti L, Del Buono A, Denaro V, Maffulli N (2010) Management of combined ACL-MCL tears: a systematic review. Br Med Bull 93(1):201–215CrossRef
30.
Zurück zum Zitat Phisitkul P, James SL, Wolf BR, Amendola A (2006) MCL injuries of the knee: current concepts review. Iowa Orthop J 26:77–90PubMedPubMedCentral Phisitkul P, James SL, Wolf BR, Amendola A (2006) MCL injuries of the knee: current concepts review. Iowa Orthop J 26:77–90PubMedPubMedCentral
31.
Zurück zum Zitat Piatkowski K, Plominski J, Sowinski T, Piekarczyk P, Kwiatkowski K, Golos J (2014) Results of two-stage operative treatment of anteromedial instability of the knee. Ortop Traumatol Rehabil 16(1):33–45CrossRef Piatkowski K, Plominski J, Sowinski T, Piekarczyk P, Kwiatkowski K, Golos J (2014) Results of two-stage operative treatment of anteromedial instability of the knee. Ortop Traumatol Rehabil 16(1):33–45CrossRef
32.
Zurück zum Zitat Rahr-Wagner L, Thillemann TM, Lind MC, Pedersen AB (2013) Validation of 14,500 operated knees registered in the Danish Knee Ligament Reconstruction Register: registration completeness and validity of key variables. Clin Epidemiol 5:219–228CrossRef Rahr-Wagner L, Thillemann TM, Lind MC, Pedersen AB (2013) Validation of 14,500 operated knees registered in the Danish Knee Ligament Reconstruction Register: registration completeness and validity of key variables. Clin Epidemiol 5:219–228CrossRef
33.
Zurück zum Zitat Roach CJ, Haley CA, Cameron KL, Pallis M, Svoboda SJ, Owens BD (2014) The epidemiology of medial collateral ligament sprains in young athletes. Am J Sports Med 42(5):1103–1109CrossRef Roach CJ, Haley CA, Cameron KL, Pallis M, Svoboda SJ, Owens BD (2014) The epidemiology of medial collateral ligament sprains in young athletes. Am J Sports Med 42(5):1103–1109CrossRef
34.
Zurück zum Zitat Roos EM, Toksvig-Larsen S (2003) Knee injury and Osteoarthritis Outcome Score (KOOS)—validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes 1:17CrossRef Roos EM, Toksvig-Larsen S (2003) Knee injury and Osteoarthritis Outcome Score (KOOS)—validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes 1:17CrossRef
35.
Zurück zum Zitat Stannard JP (2010) Medial and posteromedial instability of the knee: evaluation, treatment, and results. Sports Med Arthrosc Rev 18(4):263–268CrossRef Stannard JP (2010) Medial and posteromedial instability of the knee: evaluation, treatment, and results. Sports Med Arthrosc Rev 18(4):263–268CrossRef
36.
Zurück zum Zitat Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49 Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
37.
Zurück zum Zitat Tegner Y, Lysholm J, Lysholm M, Gillquist J (1986) A performance test to monitor rehabilitation and evaluate anterior cruciate ligament injuries. Am J Sports Med 14(2):156–159CrossRef Tegner Y, Lysholm J, Lysholm M, Gillquist J (1986) A performance test to monitor rehabilitation and evaluate anterior cruciate ligament injuries. Am J Sports Med 14(2):156–159CrossRef
38.
Zurück zum Zitat Whelan D, Chowdhry M, Hantes M, Nakamura N, Yonetani Y (2017) Treatment of MCL injury in combined ACL/MCL injury. In: Controversies in the technical aspects of ACL reconstruction: an evidence-based medicine approach. pp 371–387CrossRef Whelan D, Chowdhry M, Hantes M, Nakamura N, Yonetani Y (2017) Treatment of MCL injury in combined ACL/MCL injury. In: Controversies in the technical aspects of ACL reconstruction: an evidence-based medicine approach. pp 371–387CrossRef
39.
Zurück zum Zitat Wijdicks CA, Griffith CJ, Johansen S, Engebretsen L, LaPrade RF (2010) Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Jt Surg Am 92(5):1266–1280CrossRef Wijdicks CA, Griffith CJ, Johansen S, Engebretsen L, LaPrade RF (2010) Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Jt Surg Am 92(5):1266–1280CrossRef
40.
Zurück zum Zitat Yoshiya S, Kuroda R, Mizuno K, Yamamoto T, Kurosaka M (2005) Medial collateral ligament reconstruction using autogenous hamstring tendons: technique and results in initial cases. Am J Sports Med 33(9):1380–1385CrossRef Yoshiya S, Kuroda R, Mizuno K, Yamamoto T, Kurosaka M (2005) Medial collateral ligament reconstruction using autogenous hamstring tendons: technique and results in initial cases. Am J Sports Med 33(9):1380–1385CrossRef
Metadaten
Titel
Medial collateral ligament (MCL) reconstruction results in improved medial stability: results from the Danish knee ligament reconstruction registry (DKRR)
verfasst von
Martin Lind
Kevin Jacobsen
Torsten Nielsen
Publikationsdatum
23.05.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 3/2020
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05535-x

Weitere Artikel der Ausgabe 3/2020

Knee Surgery, Sports Traumatology, Arthroscopy 3/2020 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.